Each year, about four million people younger than 20 years old are diagnosed with sexually transmitted infections (STIs), including herpes, human papilomavirus (HPV), chlamydia, gonorrhea, and the human immunodeficiency virus (HIV). In the United States, it is estimated that 50% of the 40,000 new HIV infections each year occur in people younger than 25 and 25% occur in people younger than 21.

HIV is transmitted from person to person via bodily fluids, including blood, semen, vaginal discharge, penile secretions, and breast milk. It can be spread by sexual contact with an infected person, by sharing needles/syringes with someone who is infected, or, less commonly (and rare in countries where blood is screened for HIV antibodies), through transfusions with infected blood. HIV has been found in saliva and tears in very low quantities and concentrations in some AIDS patients. However, contact with saliva, tears, or sweat has never been shown to result in HIV transmission.

HIV/AIDS ranks as the sixth-leading cause of death among individuals aged 15-24 in the United States, with the number of AIDS cases reported each year in that age group increasing by 417% from 1981 through 1994.

Men are more likely than women to develop HIV/AIDS. According to the U.S. Centers for Disease Control and Prevention (CDC), 61% of all HIV/AIDS cases in the United States that occur in patients less than 24 years old are male. Transmission of HIV in males usually occurs after male-to-male sexual contact (74%) or high-risk heterosexual contact (13%), according to a 2001-2004 CDC survey in 33 states. About eight percent of HIV cases among 13-19 year-old males were transmitted via injection drug use.

Transmission of HIV in females usually occurs after high-risk heterosexual contact (84%) or injection drug use (15%), according to the 2001-2004 CDC survey.

The CDC also reported that African Americans aged 13-19 account for 70% of all HIV/AIDS cases diagnosed in 2004, while Caucasians accounted for 15% and Hispanics accounted for 13%.

HIV is different from many other viruses because it has exceptionally high genetic variability. The virus reproduces rapidly, generating about 109 to 1010 virions every day. Mutations are also common, with a mutation rate of about 3 x 10-5 per nucleotide base of DNA per replication cycle and recombinogenic properties of reverse transcriptase. Therefore, many HIV variants (types) can be produced in a single person in one day. That is why HIV patients receive different combinations of antiretrovirals to suppress the virus.

The first stage of HIV, known as the primary or acute infection, is a period of rapid viral replication that leads to an abundance of the virus in the bloodstream. Levels of HIV commonly approach several million viruses per milliliter of blood. During this phase, the patient experiences a drastic decline in the number of CD4 T-cells. These cells normally help the body fight against disease and infection. However, HIV infects and destroys these cells. During this stage, CD8 T-cells are activated to destroy the HIV-infected T-cells and antibodies (proteins that detect and bind to the virus) are produced. During this period, which is the most infectious stage, 80-90% of infected individuals experience flu-like symptoms.

The next stage is called clinical latency, or the window phase. This stage varies in individuals from two weeks to 20 years. During this phase, HIV is active in the lymphoid organs (tonsils, adenoids, lymph nodes, spleen, thymus gland, and other tissues involved in filtering foreign substances that enter the body) where large amounts of the virus become trapped. The surrounding tissues, which are high in CD4 T-cells, may also become infected. Viral particles accumulate in infected cells and in the bloodstream. This phase is also infectious.

Once the CD4 T-cells decline below a critical level, there is no longer cell-mediated immunity (branch of the immune system that primarily fights against viruses) and the individual experiences opportunistic infections like cytomegalovirus and Kaposi's sarcoma. At this point, the individual's condition has progressed to AIDS.

Transmission:

HIV is transmitted from person to person via bodily fluids since the virus is present in varying concentrations in the blood, semen, vaginal fluid, penile secretions, and breast milk. It can be spread by sexual contact with an infected person, by sharing needles/syringes with someone who is infected, or, less commonly (and rare in countries like the United States where blood is screened for HIV antibodies), through transfusions with infected blood.

HIV has been found in saliva and tears in very low quantities and concentrations in some AIDS patients. However, a small amount of HIV in body fluid does not necessarily mean that fluid can transmit the virus. Contact with saliva, tears, or sweat has never been shown to result in transmission of HIV.

Common risk factors among adolescents:

Most HIV-infected adolescents and young adults are exposed to the virus through sexual intercourse. Recent surveillance data suggest that most HIV-infected adolescents and young adult males are infected through sex with men. Transmission of HIV in males usually occurs after male-to-male sexual contact (74%) or high-risk heterosexual contact (13%), according to a 2001-2004 CDC survey in 33 states. Only a small percentage of males appear to be exposed by injection drug use (eight percent). These data also suggest that adolescent and young adult females infected with HIV were exposed through heterosexual contact, with a very small percentage exposed through injection drug use.

In addition, there are an increasing number of children who were infected as infants that are now surviving to adolescence.

About 25% of STI cases reported in the United States each year are among teenagers. This is particularly significant because the risk of HIV transmission increases substantially if either partner is infected with a sexually transmitted infection (STI). In addition, discharge of pus and/or mucus as a result of STIs (like gonorrhea or chlamydia) increases the risk of HIV transmission by three to five times. STI-induced ulcers from genital herpes or syphilis increase the risk of HIV transmission by nine times.

General: As soon as the virus enters the body, the immune system produces antibodies, which are chemicals that locate invaders and fight off infections. While these antibodies cannot successfully destroy the virus, their presence can be used to detect whether HIV is in the body.

It can take some time for the immune system to produce enough antibodies for the antibody test to detect them. Also, this time period, known as the "window period," varies greatly from person to person. Most people will develop detectable antibodies within two to eight weeks (the average is 25 days). However, some individuals might take longer to develop detectable antibodies. Ninety seven percent of people develop antibodies in the first three months after they contracted the infection. In very rare cases, it can take up to six months to develop antibodies to HIV. Therefore, if the initial negative HIV test was conducted within the first three months after possible exposure, repeat testing should be considered longer than three months after the exposure.

HIV tests are confidential. Individuals who are younger than 18 years old can consent to or refuse to be tested for HIV, without the involvement of their legal guardians. Test results may not be released to the patient's legal guardian(s) without his/her consent.

Pre-test counseling: According to the U.S. Centers for Disease Control and Prevention's (CDC's) new guidelines on HIV testing, HIV prevention counseling is not required to accompany HIV screening. However, the CDC still recommends that patients receive information about HIV infection, transmission and prevention, as well as HIV testing and the meaning of test results. Healthcare providers should also tell the patient when to expect results, and that confirmatory testing is necessary if the test result is positive.

Information can be provided to the patient in a face-to-face meeting with a counselor or in a pamphlet, brochure, or video. Patients who are tested with a rapid HIV test should have equal access to the same types of information.

Prevention counseling: Prevention counseling is not mandatory, but it should be offered to all patients when they receive their test results.

Counseling should focus on reducing the risks of HIV infection or transmission. The counselor should make a personalized detailed risk assessment of the patient. The counselor should also suggest achievable behavior changes that will reduce the patient's risk of developing or transmitting HIV. The counseling session is a chance to clear up any misconceptions or questions the patient has about the disease.

Enzyme immunoassay (EIA): The most common HIV tests use blood to detect HIV infection. In most cases, the enzyme immunoassay (EIA) is used to look for antibodies to HIV. A positive (reactive) EIA must be used with a follow-up (confirmatory) test such as the Western blot to make a positive diagnosis. A positive diagnosis means that a person is infected with HIV.

Western blot test: A Western blot test is typically used to confirm a positive HIV diagnosis. During the test, a small sample of blood is taken and it is used to detect HIV antibodies, not the HIV virus itself.

Saliva or urine: Tests using saliva or urine are also available. A follow-up confirmatory Western blot test should be performed if the results are positive.

Oral fluid test: An oral fluid test involves oral fluid (not saliva) that is collected from the patient's gums. This EIA antibody test is similar to the standard blood EIA test. A follow-up confirmatory Western Blot uses the same oral fluid sample.

RNA test:
RNA tests look for genetic material of HIV and can be used to screen the blood supply and to detect infection in rare cases when HIV is strongly suspected, but antibodies are not present. This is because it may take some patients up to six months to develop antibodies to HIV.

Rapid test: A rapid test produces results in about 20 minutes. Rapid tests use blood from a vein or from a finger stick, or oral fluid to look for HIV antibodies. A positive HIV test should be confirmed with a follow-up confirmatory test before a final diagnosis of infection can be made. These tests have similar accuracy rates as traditional EIA screening tests.

Home testing kit: Consumer-controlled test kits (popularly known as "home testing kits") were first licensed in 1997. The Home Access HIV-1 Test System® is a home kit that is approved by the U.S. Food and Drug Administration (FDA). The Home Access HIV-1 Test System® is sold at most local drug stores. It is not a true home test, but rather a home collection kit. The test involves pricking a finger with a special device, placing drops of blood on a specially treated card, and then mailing the card in to be tested at a licensed laboratory. Customers receive an identification number to use when calling for the results. Callers may speak to a counselor before taking the test, while waiting for the test results, and/or after the results are given. All individuals who receive a positive test result are given referrals for a follow-up confirmatory test, as well as information and resources on treatment and support services.

General: Current antiretroviral drugs cannot cure HIV infection or AIDS. They can suppress the virus, even to undetectable levels, but are unable to completely eliminate HIV from the body. The guidelines for antiretroviral treatment among adolescents are the same as for adults. However, medications for opportunistic infections (OI) may be different. Treatment for infections should be prescribed based on their stage of puberty rather than age.

In emergency situations, or if parental involvement is impossible or could cause harm, and if the patient can adhere to treatment regimens, a minor can consent to treatment without parental involvement. However, communication with legal guardians should be encouraged in all patients who are younger than 18 years old and need to make healthcare decisions.

Special considerations: Healthcare providers report that many young people, when they learn they are HIV-positive, take several months to accept their diagnosis and return for treatment. According to the U.S. Department of Health and Human Services (DHHS) Panel on Antiretroviral Guidelines for Adults and Adolescents, many adolescent HIV patients experience problems adhering to HIV treatment regimens, including denial and fear of the infection, misinformation, distrust of the medical establishment, fear and lack of belief in the medications' efficacy, low self-esteem, unstructured and chaotic lifestyles, and lack of familial and social support. Adolescents often benefit from treatment reminders (such as pill boxes, beepers, or timers).

Physical exams: During physical examination, healthcare providers should counsel male and female patients on contraception and HIV transmission prevention. Hormonal contraceptives (like the birth control pill) should not be used alone because they do not prevent sexually transmitted diseases. Therefore, barrier birth control methods (like condoms or diaphragms) may be used. Also, interactions between antiretroviral medications and birth control pills should be discussed. Antiretrovirals like efavirenz (Sustiva®) may inhibit the effectiveness of birth control pills. The potential for pregnancy may also alter antiretroviral treatment options. For instance, efavirenz (Sustiva®) should not be used during pregnancy because it is associated with a high risk of birth defects. Efavirenz should only be used after the patient tests negative for pregnancy and understands the potential risks of the medication.

Opportunistic infections: Pediatric doses of antibiotics should be prescribed for adolescents in early puberty (Stage I and II). Stage I is pre-pubertal. During stage II, individuals have a small amount of soft pubic hair. In males, the skin on the scrotum thins, reddens and enlarges. Breast buds form in females, and the areola begins to widen. Adolescents who are in the middle of their growth spurt (Tanner III females and Tanner IV males) should be closely monitored for medication efficacy and toxicity when choosing adult or pediatric dosing guidelines. During this phase, the female's breasts begin to elevate and the areola continues to widen. During this phase, males have a testicular volume between 12 and 20 milliliters, the scrotum continues to enlarge, and the penis increases in length and volume. Adolescents in late puberty (Tanner V) should receive adult dosages and schedules.

Highly active antiretroviral therapy (HAART): When HIV reproduces, different strains of the virus emerge, and some are resistant to antiretroviral drugs. Therefore, it is common for healthcare providers to recommend a combination of antiretroviral drugs known as HAART. This strategy, developed by National Institute of Allergy and Infectious Diseases (NIAID)-support researchers, usually combines drugs from at least two different classes of antiretroviral drugs, and it has been shown to suppress, but not eliminate, the virus. The sooner HIV patients begin HAART, the longer the likelihood of their survival.

Individuals infected with HIV have impaired immune systems, which can make them vulnerable to opportunistic infections (OIs) and AIDS-associated co-infections. A wide-range of microorganisms like protozoa, viruses, fungi, and bacteria cause the infections. Hepatitis C virus (HCV) infection is just one example. However, HIV therapies like HAART have dramatically slowed the progression of OIs and AIDS associated co-infections in HIV infected individuals.

Currently, the FDA has approved several antiretroviral drugs to treat HIV-infected individuals. These drugs fall into three major classes: reverse transcriptase (RT) inhibitors, protease inhibitors, and fusion inhibitors. In July 2006, the FDA approved a multi-class combination called Atripla®.

Fusion inhibitors prevent the virus from fusing with the cellular membrane, thus blocking entry into the cell. The fusion inhibitor Fuzeon® is FDA-approved.

Protease inhibitors (PIs) interfere with the protease enzyme that HIV uses to produce infectious viral particles. PIs prevent viral replication by inhibiting the activity of protease, an enzyme used by the virus to cleave nascent proteins for final assembly of new virons.
FDA-approved protease inhibitors include Agenerase®, Aptivus®, Crixivan®, Invirase®, Kaletra®, Lexiva®, Norvir®, Prezista®, Reyataz®, and Viracept®.

Antiretroviral adverse effects:
Individuals taking antiretroviral drugs often have a difficult time following complicated drug regimens. The current recommended treatment requires patients to take several antiretroviral drugs every day from at least two different classes. Also, some of the drugs require not eating before or after taking the pill and may cause side effects such as nausea and vomiting. Other antiretroviral drugs may cause serious medical problems, including changes in metabolism like abnormal lipid and glucose metabolism (which may cause changes in the body shape due to loss and/or accumulation of body fat), as well as bone loss. The National Institute of Allergy and Infectious Diseases is among many research organizations that is investigating simpler, less toxic, and more effective drug regimens.

Supportive care and counseling: HIV-infected adolescents face unique challenges when it comes to accepting and treating their diseases. Many adolescents are in denial, afraid, misinformed or lack familial or social support. Therefore, this age group may benefit from counseling services and supportive care.

The Adolescent AIDS Program (AAP) at Children's Hospital at Montefiore in New York is the country's first adolescent AIDS program. It is considered a leader in the field of HIV prevention, care and research. The organization specializes in providing medical care and counseling services to adolescents who are HIV-positive or who are at-risk for HIV infection. In addition to clinical services, the AAP provides specialized HIV training to medical and mental healthcare professionals who treat adolescents, they design and implement innovative HIV prevention campaigns targeting at-risk youth, and participate in HIV research in diverse adolescent patient populations.

Note: Integrative therapies should not replace antiretroviral therapy (ART) in HIV patients. Patients should consult their healthcare providers before taking any herbs or supplements because they may interact with treatment. Patients should not take St. John's wort because it may interact with HIV treatment.

Unclear or conflicting scientific evidence:

Aloe vera:
Clear gel from the pulp of Aloe vera leaves has been used on the skin for thousands of years to treat wounds, skin infections, minor burns, and other skin conditions. Although aloe has been suggested as a possible treatment for HIV infection, further research is needed before a firm conclusion can be made.

Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, and tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds, or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools, or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease, or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.

Alizarin: Limited available evidence suggests that alizarin may be of benefit in the treatment of viral infections. Additional research is needed in this area.

Avoid if allergic or hypersensitive to alizarin or any plants in the Rubiaceae family. Alizarin may be toxic and should not be handled for long periods of time, rubbed in the eyes, or eaten. Avoid if pregnant or breastfeeding.

Antineoplastons:
Antineoplastons are substances found in human blood and urine. Preliminary study reported increased energy and weight in patients with HIV who were treated with antineoplaston AS2-1, as well as a decreased number of opportunistic infections and increased CD4 cell counts. However, this evidence cannot be considered conclusive. Currently, there are drug therapy regimens available for HIV with clearly demonstrated effects (highly active anti-retroviral therapy), and patients with HIV are recommended to consult with their physicians about treatment options.

Avoid if allergic or hypersensitive to antineoplastons. Use cautiously with high medical or psychiatric risk. Use cautiously with an active infection due to a possible decrease in white blood cells. Use cautiously with high blood pressure, heart conditions, chronic obstructive pulmonary disease, liver disease/damage, or kidney disease/damage. Avoid if pregnant or breastfeeding.

Astragalus: Antiviral effects have been reported in early studies for HIV. Additional research is warranted.

Avoid if allergic to astragalus, peas, or any related plants or with a history of Quillaja bark-induced asthma. Avoid with aspirin or aspirin products or herbs or supplements with similar effects. Avoid with inflammation (swelling) or fever, stroke, transplant or autoimmune diseases (like HIV/AIDS). Stop use two weeks before surgery/dental/diagnostic procedures with a risk of bleeding and avoid use immediately after these procedures. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders or kidney disorders. Use cautiously with blood-thinners, blood sugar drugs, or diuretics or herbs and supplements with similar effects. Avoid if pregnant or breastfeeding.

Beta sitosterol: Beta-sitosterol is found in plant-based foods, such as fruits, vegetables, soybeans, breads, peanuts, and peanut products. It is also found in bourbon and oils (such as olive oil, flaxseed, and tuna). Due to data that suggest immune modulating effects of beta-sitosterol and beta-sitosterol glucoside, these sterols have been studied in combination in the treatment of HIV. Larger populations of patients with HIV should be evaluated in randomized controlled trials to draw any conclusions.

Avoid if allergic or hypersensitive to beta-sitosterol, beta-sitosterol glucoside, or pine. Use cautiously with asthma or breathing disorders, diabetes, primary biliary cirrhosis (destruction of the small bile duct in the liver), ileostomy, neurodegenerative disorders (like Parkinson's disease or Alzheimer's disease), diverticular disease (bulging of the colon), short bowel syndrome, celiac disease, and sitosterolemia. Use cautiously with a history of gallstones. Avoid if pregnant or breastfeeding.

Bitter melon: Laboratory studies have shown that a protein in bitter melon called MAP30 may have antiviral activity against HIV. However, this has not been studied in humans. Further research is needed before a firm conclusion can be made.

Avoid if allergic to bitter melon or members of the Curcurbitaceae (gourd or melon) family. Avoid ingesting bitter melon seeds. Avoid with glucose-6-phosphate dehydrogenase deficiency. Use cautiously with diabetes, glucose intolerance, or with hypoglycemic agents due to the risk of hypoglycemia (low blood sugar). Avoid if pregnant or breastfeeding.

Blessed thistle: Laboratory studies report no activity of blessed thistle against herpes viruses, influenza, or poliovirus. Effects of blessed thistle (or chemicals in blessed thistle called lignans) against HIV are not clear. Human research of blessed thistle as a treatment for viral infections is lacking.

Blessed thistle is generally considered to be safe when taken by mouth in recommended doses for short periods of time, with few reported side effects such as birth defects, bleeding, breathing problems, bruising, cancer of the nose or throat, increased production of stomach acid, itching, kidney disease, liver toxicity, skin rash, stomach discomfort, stomach ulcers, and vomiting. Allergic reactions to blessed thistle including rash may occur, as well as cross-sensitivity to mugwort and Echinacea. Cross-reactivity may also occur with bitter weed, blanket flower, Chrysanthemum, coltsfoot, daisy, dandelion, dwarf sunflower, goldenrod, marigold, prairie sage, ragweed or other plants in the Asteraceae/Compositae family. Avoid if pregnant or breastfeeding.

Boxwood: Trials have been conducted for SPV30 (extract of boxwood, Arkopharma, France) to evaluate its potential effectiveness for HIV/AIDS. Rigorous clinical study is needed to confirm these early study results.

Avoid if allergic or hypersensitive to boxwood, its constituents, or any plants in the Buxaceae family. Use cautiously with HIV or AIDS. Avoid if pregnant or breastfeeding.

Carrageenan: Carrageenan-based gels may reduce HIV transmission during sexual intercourse and have been investigated for safety and acceptability in published studies involving healthy females. Overall, studies suggest that carrageenan is not associated with abnormal genital clinical findings or severe side effects, and is considered acceptable for use by females and their male partners. Additional research is needed to better determine the role of carrageenan for HIV infection prevention.

Use oral carrageenan cautiously in infants. Use cautiously in patients with, or at risk for, cancer. Use cautiously in patients treated with azoxymethane or nitrosomethylurea. Use cautiously in patients with gastrointestinal, immune, inflammatory, or bleeding disorders, or in patients with low blood pressure or diabetes. Use cautiously intravaginally. Use cautiously in patients using antilipemic agents. Use cautiously in combination with any oral medication, as the fiber in carrageenan may impair the absorption of oral medications.

Chiropractic: Chiropractic care focuses on how the relationship between musculoskeletal structure (mainly the spine) and bodily function (mainly nervous system) affects health. There is currently not enough reliable scientific evidence to conclude the effects of chiropractic techniques on CD4 cell count or quality of life in patients with HIV/AIDS.

Use extra caution during cervical adjustments. Use cautiously with acute arthritis, conditions that cause decreased bone mineralization, brittle bone disease, bone softening conditions, bleeding disorders or migraines. Use cautiously with the risk of tumors or cancers. Avoid with symptoms of vertebrobasilar vascular insufficiency, aneurysms, unstable spondylolisthesis, or arthritis. Avoid with agents that increase the risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if pregnant or breastfeeding due to a lack of scientific data.

Coenzyme Q10:
Coenzyme Q10 (CoQ10) is produced by the body and it is necessary for basic functioning of cells. CoQ10 levels decrease with age. There is limited evidence that natural levels of CoQ10 in the body may be reduced in people with HIV/AIDS. Reliable scientific research showing that CoQ10 supplements have any effect on this disease is currently lacking.

There are currently no documented cases of allergy associated with Coenzyme Q10 supplements, although rash and itching have rarely been reported. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Use cautiously with history of blood clots, diabetes, high blood pressure, heart attack, or stroke. Use cautiously with anticoagulants (blood thinners), antiplatelet drugs, blood pressure drugs, blood sugar drugs, cholesterol drugs, or thyroid drugs. Avoid if pregnant or breastfeeding.

Cranberry: Limited laboratory research has examined the antiviral activity of cranberry. Further research is warranted in this area.

Avoid if allergic to cranberries, blueberries, or other plants of the Vaccinium species. Sweetened cranberry juice may affect blood sugar levels. Use cautiously with a history of kidney stones. Pregnant and breastfeeding women should avoid cranberry in higher amounts than what is typically found in foods.

DHEA:
DHEA (dehydroepiandrosterone) is a hormone that is secreted by the adrenal glands. Although some studies suggest that DHEA supplementation may be beneficial in patents with HIV, results from different studies do not agree with each other. There is currently not enough scientific evidence to recommend DHEA for AIDS, and other therapies are more proven in this area.

Avoid if allergic to DHEA. Avoid with a history of seizures. Use cautiously with adrenal or thyroid disorders. Use cautiously if taking anticoagulants, or drugs, herbs, or supplements for diabetes, heart disease, seizures, or stroke. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Avoid if pregnant or breastfeeding.

Flaxseed and flaxseed oil:
Flaxseed and flaxseed oil/linseed oil are rich sources of the essential fatty acid, alpha-linolenic acid (omega-6). While flaxseed has been used to treat HIV/AIDS, no strong evidence supports its use and no recommendation can be made without further research.

Flaxseed has been well tolerated in studies for up to four months. Avoid if allergic to flaxseed, flaxseed oil, or other plants of the Linaceae family. Avoid with prostrate cancer, breast cancer, uterine cancer, or endometriosis. Avoid ingestion of immature flaxseed pods. Avoid large amounts of flaxseed by mouth and mix plenty of water or liquid. Avoid flaxseed (not flaxseed oil) with history of esophageal stricture, ileus, gastrointestinal stricture, or bowel obstruction. Avoid with history of acute or chronic diarrhea, irritable bowel syndrome (IBS), diverticulitis (inflammation of the diverticula, small sacs in the intestine's inner lining), or inflammatory bowel disease (IBD). Avoid topical flaxseed in open wounds or abraded skin surfaces. Use cautiously with history of a bleeding disorder or with drugs that increase the risk of bleeding (such as anticoagulants and non-steroidal anti-inflammatories). Use cautiously with high triglyceride levels, diabetes, mania, seizures, or asthma. Avoid if pregnant or breastfeeding.

Green tea: Green tea is made from the dried leaves of Camellia sinensis, a perennial evergreen shrub. Green tea has a long history of use, dating back to China approximately 5,000 years ago. Green tea, black tea, and oolong tea are all derived from the same plant. Preliminary research suggests that green tea may decrease viral load in carriers of the human T-cell lymphocytic virus. Additional well-designed controlled research is needed before a conclusion can be made.

Avoid if allergic or hypersensitive to caffeine or tannins. Use cautiously with diabetes or liver disease.

Healing Touch: Healing touch (HT) is a combination of hands-on and off-body techniques that influence the flow of energy through a person's biofield. Data from small preliminary studies are insufficient to support any recommendations for or against use of HT in HIV/AIDS patients. Studies of better design are needed before any conclusions can be reached.

HT should not be regarded as a substitute for established medical treatments. Use cautiously if pregnant or breastfeeding.

L-carnitine: L-carnitine may be beneficial in AIDS treatment by increasing proliferation of mononuclear cells and increasing CD4 counts. Additional study is needed to make a firm recommendation.

Avoid if allergic or hypersensitive to carnitine. Use cautiously with peripheral vascular disease, high blood pressure, alcohol-induced liver cirrhosis, and diabetes. Use cautiously in low birth weight infants and individuals on hemodialysis. Use cautiously if taking anticoagulants (blood thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or breastfeeding.

Licorice: Early studies suggest that glycyrrhizin may inhibit HIV replication in patients with AIDS. However, human reports are lacking. Additional study is needed to make a conclusion.

Avoid with a known allergy to licorice, any component of licorice, or any member of the Fabaceae (Leguminosae) plant family. Avoid with congestive heart failure, coronary heart disease, kidney or liver disease, fluid retention, high blood pressure, hormonal abnormalities or with use of diuretics. Licorice can cause abnormally low testosterone levels in men or high prolactin or estrogen levels in women. This may make it difficult to become pregnant and may cause menstrual abnormalities.

Massage: Evidence is limited and mixed as to whether massage may be of benefit for immune functioning or health services utilization in people with HIV/AIDS.

Avoid with bleeding disorders, low platelet counts, or if on blood-thinning medications (such as heparin or warfarin/Coumadin®). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.

Meditation: Various forms of meditation have been practiced for thousands of years throughout the world, with many techniques originating in Eastern religious practices. A common goal is to attain a state of "thoughtless awareness" of sensations and mental activities occurring at the present moment. More studies are needed to establish how meditation may be useful as an adjunctive therapy in HIV/AIDS patients.

Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professionals before starting a program of meditation and they should explore how meditation may or may not fit in with their current treatment plans. Avoid with risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies, and it should not be used as the sole approach to illnesses.

Melatonin: Melatonin is a neurohormone produced in the brain. There is a lack of well-designed scientific evidence to recommend for or against the use of melatonin as a treatment for AIDS. Melatonin should not be used in place of more proven therapies, and patients with HIV/AIDS should be treated under the supervision of their healthcare professionals.

Based on available studies and clinical use, melatonin is generally regarded as safe in recommended doses for short-term use. There are rare reports of allergic skin reactions after taking melatonin by mouth. Use cautiously with bleeding disorders, seizure disorders, or if taking drugs that increase the risk of bleeding.

Mistletoe: Treatment of HIV patients with mistletoe has been conducted in Europe since the beginning of the AIDS epidemic. Treatment seems to be tolerable with minimal side effects reported. Mistletoe may assist in inhibiting disease progression. However, not all mistletoe preparations have shown equal effects. Further study is needed before a firm conclusion can be made.

Avoid if allergic or hypersensitive to mistletoe or to any of its constituents. Anaphylactic reactions (life threatening, shock) have been described after injections of mistletoe. Avoid with acute, highly febrile, inflammatory disease, thyroid disorders, seizure disorders, or heart disease. Use cautiously with diabetes, glaucoma, or with cholinergics.

Prayer/distant healing: Prayer can be defined as a "reverent petition," the act of asking for something while aiming to connect with God or another object of worship. Limited study of prayer in patients with HIV/AIDS reports fewer new AIDS-related illnesses and hospitalizations. However, due to methodological problems, these results cannot be considered conclusive.

Prayer is not recommended as the sole treatment approach for potentially serious medical conditions, and it should not delay the time it takes to consult with a healthcare professional or receive established therapies. Sometimes religious beliefs come into conflict with standard medical approaches and require an open dialog between patients and caregivers.

Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health professional. The patient will explore thoughts, feelings, and behaviors to help with problem solving. Psychotherapy, especially supportive psychotherapy, may reduce depression in HIV-positive patients. It may also help with treating substance abuse when used in combination with prescription medicine. Supportive-expressive group therapy may also have concomitant improvements in CD4 cell count and viral load. More research is needed in this area, especially to determine the best type of psychotherapy.

Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases, symptoms may get worse if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illness or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings and expression.

Reiki: Reiki instruction may help reduce pain or anxiety in HIV/AIDS patients, but results are unclear.

Reiki is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time it takes to consult with a healthcare professional or receive established therapies. Use cautiously with psychiatric illnesses.

Relaxation therapy: Relaxation techniques include behavioral therapeutic approaches that differ widely in philosophy, methodology, and practice. Mental health and quality-of-life improvements have been seen in preliminary studies of HIV/AIDS patients. These findings suggest the need for further, well-controlled research.

Avoid with psychiatric disorders like schizophrenia/psychosis. Jacobson relaxation (flexing specific muscles, holding that position, then relaxing the muscles) should be used cautiously with illnesses like heart disease, high blood pressure, or musculoskeletal injury. Relaxation therapy is not recommended as the sole treatment approach for potentially serious medical conditions, and it should not delay the time to diagnosis or treatment with more proven techniques.

Selenium: Selenium is a mineral found in soil, water, and some foods. Selenium supplementation has been studied in HIV/AIDS patients, and some reports associate low selenium levels with complications such as cardiomyopathy. It remains unclear if selenium supplementation is beneficial in patients with HIV, particularly during antiretroviral therapy.

Avoid if allergic or sensitive to products containing selenium. Avoid with history of non-melanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.

Shiitake: Based on preliminary studies, lentinan from shiitake mushroom may increase CD4 counts and may be effective as an adjunct therapy in HIV. Further well-designed studies are needed to confirm these results. Side effects have been reported and more proven therapies are recommended at this time.

Avoid if allergic or hypersensitive to shiitake mushrooms. Avoid if pregnant or breastfeeding.

Sorrel: There is currently not enough evidence on the proposed antiviral effects of sorrel. More research is needed.

Avoid large doses of sorrel because there have been reports of toxicity and death. This may be because of the oxalate found in sorrel. Many sorrel tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. These sorrel formulations may cause nausea or vomiting when taken with the prescription drugs metronidazole (Flagyl®) or disulfiram (Antabuse®). Avoid if pregnant or breastfeeding.

Spiritual healing: Distant healing and prayer have been used in patients with HIV/AIDS. There is conflicting evidence in this area and more study is needed.

Spiritual healing should not be used as the only treatment approach for medical or psychiatric conditions, and should not delay the time it takes to consider more proven therapies.

Therapeutic touch: There is currently not enough evidence that therapeutic touch may benefit immunity or emotional well-being in HIV/AIDS patients. More research is needed.

Avoid with fever or inflammation, and on areas of the body with cancer.

Thymus extract: Thymus extracts for nutritional supplements are usually derived from young calves. Preliminary evidence found no improvement in HIV progression to AIDS or immunostimulation, although some immunological activity was noted in a non-randomized controlled trial. Additional study is needed to better understand the effects of thymus extract for HIV/AIDS.

Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to potential for exposure to the virus that causes "mad cow disease." Avoid use with an organ transplant or other forms of allografts or xenografts. Avoid if receiving immunosuppressive therapy or hormone therapy. Avoid with thymic tumors, myasthenia gravis (neuromuscular disorder), or untreated hypothyroidism. Avoid if pregnant or breastfeeding. Thymic extract increases human sperm motility and progression.

Traditional Chinese medicine (TCM): Traditional Chinese medicine (TCM) is a broad term that refers to many different treatments and traditions of healing. They share a common heritage of technique or theory rooted in ancient Chinese philosophy (Taoism) that dates back over 5,000 years. TCM herbs are a popular complementary therapy in HIV/AIDS. However, study results conflict. More studies are needed before the potential benefits of TCM herbs in HIV/AIDS can be established.

Chinese herbs can be potent and may interact with other herbs, foods, or drugs. Consult a qualified healthcare professional before taking. There have been reports of manufactured or processed Chinese herbal products being tainted with toxins or heavy metal or not containing the listed ingredients. Herbal products should be purchased from reliable sources. Avoid ma huang, which is the active ingredient in ephedra. Avoid ginseng if pregnant or breastfeeding.

Turmeric: Turmeric is a perennial plant native to India and Indonesia, and it is often used as a spice in cooking. Based on early research, turmeric may help treat various viral infections. Several laboratory studies suggest that curcumin, a component of turmeric, may have activity against HIV/AIDS. However, reliable human studies are lacking in this area.
Well-designed trials are needed.

Avoid if allergic or hypersensitive to turmeric (curcumin), yellow food colorings, or plants belonging to the Curcuma or Zingiberaceae (ginger) families. Use cautiously with a history of bleeding disorders, immune system deficiencies, liver disease, or gallstones. Use cautiously with blood thinners (e.g. warfarin). Use cautiously if pregnant or breastfeeding.

Vitamin A: Vitamin A is a fat-soluble vitamin that is derived from two sources:
retinoids and carotenoids. Retinoids are found in animal sources (such as the liver, kidney, eggs, and dairy products). Carotenoids are found in plants like dark or yellow vegetables and carrots. The role of vitamin A in the prevention, transmission, or treatment of HIV infection is controversial and not well established. A clear conclusion cannot be formed based on the available scientific research.

Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may have an increased risk for lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken at recommended doses. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.

Zinc:
Patients with HIV/AIDS, especially those with low zinc levels, may benefit from zinc supplementation. Some low quality studies cite reduction in infections, enhanced weight gain, and immune system function, including increased CD4 and CD8 cells, with use of zinc. However, other low quality studies conflict with these findings. Further research is needed before a conclusion can be made.

Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. While zinc appears safe during pregnancy in amounts lower than the established upper intake level, caution should be used since studies cannot rule out the possibility of harm to the fetus.

Fair negative scientific evidence:

Ozone therapy: Ozone molecules are composed of three oxygen atoms. Ozone exists high in the earth's atmosphere and absorbs radiation from the sun. Reports of using ozone for medicinal purposes date to the late 19th Century. Laboratory studies have shown the HIV virus to be sensitive to ozone, but high-quality human studies are lacking. A preliminary study measured the safety and effectiveness of ozone-treated blood in the treatment of HIV infection and immune disease. Ozone therapy was not shown to enhance immune activation or diminish the HIV virus.

Autohemotherapy (a therapy in which blood is withdrawn from the body) infused with ozone, and then replaced into the body), has been associated with transmission of viral hepatitis and with a possible case of dangerously lowered blood cell counts. Insufflation of the ear carries a risk of tympanic membrane ("ear drum") damage, and colon insufflation may increase the risk of bowel rupture. Consult a qualified health professional before undergoing any ozone-related treatment.

St John's wort:
Anti-viral effects of St. John's wort have been observed in laboratory studies, but were not found in available human study. Multiple reports of significant adverse effects and interactions with drugs used for HIV/AIDS, including protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), suggest that patients being treated for HIV/AIDS should avoid this herb. Therefore, there is evidence to recommend against using St. John's wort in the treatment of patients with HIV/AIDS.

Avoid if allergic or hypersensitive to plants in the Hypericaceaefamily. Rare allergic skin reactions like itchy rash have been reported. Avoid with immunosuppressant drugs (such as cyclosporine, tacrolimus, or myophenic acid). Avoid with non-nucleoside reverse transcriptase inhibitors or protease inhibitors. Avoid with organ transplants, suicidal symptoms, or before surgery. Use cautiously with history of thyroid disorders. Use cautiously with drugs that are broken down by the liver, with monoamine oxidase inhibitors (MAOI) or selective serotonin reuptake inhibitors (SSRIS), digoxin, or birth control pills. Use cautiously with diabetes or with history of mania, hypomania, or seasonal affective disorder (SAD). Avoid if pregnant or breastfeeding.

Wear gloves when in contact with blood or other body fluids that could possibly contain blood, such as urine, feces, or vomit.

Cuts, scrapes, sores, or breaks on the exposed skin of both the caregiver and patient should be covered with bandages.

Wash any body area that came into contact with blood or other body fluids. Surfaces that have been tainted with blood should be disinfected appropriately.

Practices that increase the likelihood of blood contact, such as sharing of razors and toothbrushes and nail clippers should be avoided.

Needles and other sharp instruments should be used only when medically necessary and handled appropriately.

In 1985, the U.S. Centers for Disease Control and Prevention (CDC) issued a list of routine precautions for all personal-service workers (such as hairdressers, barbers, cosmetologists, and massage therapists). Instruments that penetrate the skin (like tattoo and acupuncture needles or ear piercing guns) should either be used once and disposed of or thoroughly sterilized. Instruments that are not meant to penetrate the skin, but may come in contact with blood (like razors), should not be shared unless thoroughly sterilized.

Individuals, especially those who engage in high-risk behaviors that may lead to HIV infection, should be tested for HIV annually.

Antiviral therapy during pregnancy can significantly lower the chance that the virus will be passed to the infant before, during, or after birth. The treatment is most effective if it is started as early as possible during pregnancy. However, there are still health benefits if treatment is begun during labor or shortly after the baby is born.

Infected mothers should not breastfeed their newborn(s).

Delivering the baby by cesarean section has been shown to reduce the risk of transmission to the newborn. However, this is not the standard preventative care for HIV-infected pregnant women. It should only be considered in certain clinical circumstances (such as for patients who have a very high viral overload or for patients who do not adhere to antiretroviral therapy).

Prevention programs:

HIV/AIDS can be prevented if people are educated about the disease, tested regularly for the disease and practice safe sex. Several educational programs aimed at adolescents have been developed to educate the public about the risks of HIV/AIDS.

The U.S. Centers for Disease Control and Prevention (CDC) has developed HIV prevention programs for teenagers, including a national public information campaign, the CDC National AIDS Hotline, and the AIDS Clearinghouse. These programs include activities that are designed to educate the public, including teenagers, about how the virus is transmitted, who is at risk for acquiring the infection, and how to prevent it.

In mid-November 2005, Advocates for Youth and Sex, Etc. launched an educational campaign titled, "Respect Yourself, Protect Yourself." The campaign was established to place emphasis on the importance of educating young adults aged 18-25 and works to promote open and honest discussion about safe sex, pregnancy, and sexually transmitted diseases across the country.

Many people are asymptomatic (experience no symptoms) when they first become infected with HIV. After one or two months, it is common for individuals to experience flu-like symptoms including headache, fever, fatigue, and enlarged lymph nodes.

These symptoms usually disappear after one week to one month and are often mistaken for another viral infection. Despite having minimal or no symptoms during this stage, individuals are very infectious and the virus is present in large quantities in bodily fluids.

The most obvious sign of HIV infection at a decrease in the number of CD4 T-cells that fight infection and are found in the blood. The virus slowly kills these cells without causing symptoms. Even when the infected individual is asymptomatic, the virus is multiplying, infecting, and destroying cells in the immune system.

Clinical latency symptoms:

During the next stage, known as clinical latency, more serious symptoms arise. Once infected with HIV, it may take 10 or more years for more severe symptoms to appear in adults, or up to two years in children who are born with HIV infection. The length of this asymptomatic period varies among individuals. Some people may start to experience more serious symptoms within a few months, while others may be symptom-free for several years. The virus can also hide within infected cells and lay dormant.

As the immune system continues to weaken, many symptoms appear, including swollen lymph nodes (swollen glands) that may be enlarged for more than three months. Other symptoms often experienced months to years before the onset of AIDS may include fatigue, weight loss, frequent fevers and sweats, persistent or frequent yeast infections (oral or vaginal), persistent skin rashes or flaky skin, short-term memory loss, and pelvic inflammatory disease (PID) in women that does not respond well to treatment.

In addition, some individuals develop shingles (painful nerve disease) or frequent and severe herpes infections that cause mouth, genital, or anal sores. Infected children may grow slowly or be sick often.

AIDS symptoms:

Once the CD4 T-cells decline below a critical level, there is no longer cell-mediated immunity (branch of the immune system that primarily fights off viruses that enter the body) and the individual experiences opportunistic infections (infections that occur in individuals with weakened immune systems). The individual's condition has progressed to AIDS.

The first symptoms often include moderate and unexplained weight loss, recurring respiratory tract infections, and oral ulcers.

Opportunistic infections and tumors, which are often fatal, may include tuberculosis, thrush, herpes viruses, shingles, Epstein-Barr virus, Kaposi's sarcoma (a type of cancer), and pneumonia.

In the last stages of AIDS, it is common for individuals to have cytomegalovirus (viral infection related to herpes) or Mycobacterium avium complex infections (bacterial infection).

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.